Podcast
Questions and Answers
Which of the following is a method used to measure serum enzyme activity?
Which of the following is a method used to measure serum enzyme activity?
Acute myocardial infarction results from a blockage in the vessels caused by atherosclerotic plaque rupture.
Acute myocardial infarction results from a blockage in the vessels caused by atherosclerotic plaque rupture.
True
What is the primary difference between acute myocardial infarction (AMI) and unstable angina?
What is the primary difference between acute myocardial infarction (AMI) and unstable angina?
AMI involves tissue damage, while unstable angina does not.
The enzyme activity of aspartate aminotransferase is calculated using the formula: activity (µmol/min/ml) = 6.22 x ______.
The enzyme activity of aspartate aminotransferase is calculated using the formula: activity (µmol/min/ml) = 6.22 x ______.
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Match the following biomarkers with their methods of measurement:
Match the following biomarkers with their methods of measurement:
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Which condition is indicative of an imbalance between myocardial oxygen supply and demand?
Which condition is indicative of an imbalance between myocardial oxygen supply and demand?
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All patients presenting with acute chest pain have experienced an acute myocardial infarction.
All patients presenting with acute chest pain have experienced an acute myocardial infarction.
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What requirement must serum biomarkers meet to be considered effective in diagnosis?
What requirement must serum biomarkers meet to be considered effective in diagnosis?
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Which isoform of creatine kinase is primarily used for acute myocardial infarction (AMI) detection?
Which isoform of creatine kinase is primarily used for acute myocardial infarction (AMI) detection?
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Creatine kinase MB is only present in heart tissue.
Creatine kinase MB is only present in heart tissue.
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What biomarker is produced in response to stress on the atrial and ventricle wall in heart failure?
What biomarker is produced in response to stress on the atrial and ventricle wall in heart failure?
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A normal NT-proBNP result has a strong __________ value for heart failure.
A normal NT-proBNP result has a strong __________ value for heart failure.
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Which biomarker is specifically associated with acute myocardial infarction (AMI)?
Which biomarker is specifically associated with acute myocardial infarction (AMI)?
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Match the following serum biomarkers with their functions:
Match the following serum biomarkers with their functions:
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Troponin T is the only troponin isoform used as a biomarker for AMI.
Troponin T is the only troponin isoform used as a biomarker for AMI.
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What is the role of Pro-BNP as a biomarker of heart damage?
What is the role of Pro-BNP as a biomarker of heart damage?
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What is a potential limitation of using BNP as a biomarker?
What is a potential limitation of using BNP as a biomarker?
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Serum creatine kinase levels are always high in normal individuals.
Serum creatine kinase levels are always high in normal individuals.
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Troponin I isoforms are found in ______ muscle tissue.
Troponin I isoforms are found in ______ muscle tissue.
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What diagnostic tool is recommended following a raised NT-proBNP or BNP level?
What diagnostic tool is recommended following a raised NT-proBNP or BNP level?
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Match the following troponin isoforms with their specific muscle type:
Match the following troponin isoforms with their specific muscle type:
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What is recommended for diagnosing AMI in terms of troponin sampling?
What is recommended for diagnosing AMI in terms of troponin sampling?
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Myocarditis can lead to the release of troponins into the bloodstream.
Myocarditis can lead to the release of troponins into the bloodstream.
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Name one limitation of the current troponin I assays.
Name one limitation of the current troponin I assays.
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Study Notes
Heart and Muscle Damage
- This presentation discusses heart and muscle damage, covering learning outcomes, diagnosis and management, screening, assay of biomarkers, acute myocardial infarction, and a summary of the key factors.
Learning Outcomes
- Understanding how serum enzymes, proteins, and metabolites are used as diagnostic tools.
- Identifying methods used to measure serum enzymes, proteins, and metabolites.
- Applying diagnostic principles to acute myocardial infarction and heart failure.
Recap
- Diagnosis: Assessing the presence of a condition.
- Management: Strategies for treating a disease.
- Progression of disease: How the condition develops.
- Response to treatment: How the condition responds to therapies.
- Recurrence of disease: The potential for the condition to return
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Screening: Identifying potential cases among asymptomatic individuals.
- Population screening: Testing a whole population, like newborns.
- Selected group screening: Testing specific groups, such as obese patients for type II diabetes.
- Individual screening: Testing specific individuals, for example, those with familial hypercholesterolaemia.
Tissue Specific Biomarkers
- These markers are only produced in specific tissue types
- They sharply increase in response to damage.
- They are usually present at extremely low levels in healthy individuals.
- They are measured easily with universal reference values.
- A combination of different tests is sometimes used to obtain a precise profile when a single test is insufficient.
Assay of Serum Biomarkers
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Enzyme activity: Measures the rate of a chemical reaction, such as that produced by aspartate aminotransferase. This measures the speed at which the enzyme converts the substances aspartate + 2-oxoglutarate to glutamate + oxaloacetate, using NAD+ and NADH.
- Rate is often measured using the change in absorbance.
- Extinction coefficient for NADH = 6.22 mM-1 cm-1
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Amount of protein/enzyme: Assays using immunological methods, like ELISA.
- Different types of ELISA include direct, indirect, sandwich, and competitive ELISAs.
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Metabolites: Detecting chemical conversions to coloured products using spectrophotometric measurements.
- The Beer-Lambert law is used and needs to remain within the linear range.
Acute Myocardial Infarction (AMI)
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Cause: Imbalance between myocardial (heart muscle) oxygen supply and demand which leads to injury/death of muscle tissue.
- Often a result of coronary thrombosis.
- The thrombosis results from a fissure or rupture of the intimal lining of the atherosclerotic plaque. This blockage reduces blood supply to the affected area
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CHD (Coronary Heart Disease): Leading cause of death in many countries, with approximately 64,000 deaths each year in the UK. One death in the UK every eight minutes. CHD is one of the UK's leading causes of death and the most common cause of premature death.
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Diagnosis:
- Subjects with acute chest pain may be suffering from AMI, unstable angina, or other conditions.
- AMI patients will show ST segment elevation in the Electrocardiogram (ECG).
- Non-ST segment elevated MI (NSTEMI) is identified through changes in T waves or ST depression/no change in ECG.
- Only approximately 75% of AMI patients show diagnostic changes in the ECG.
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Causes other than AMI: Other conditions can result in elevated biomarkers, including myocarditis (an inflammation of the heart muscle), and pulmonary embolism (a blockage in the pulmonary arteries).
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Summary: Serum proteins' diagnostic value is increased when using a sensitive detection method like ELISA. Reduced oxygen supply to the heart, leading to tissue death, defines myocardial infarction. Biochemical tests are necessary for confirming the diagnosis, despite the usefulness of non-biochemical methods.
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Description
This quiz covers key aspects of heart and muscle damage, focusing on diagnosis, management, and the role of biomarkers. It discusses the principles of assessing conditions like acute myocardial infarction and heart failure, along with strategies for treatment and screening methods. Enhance your understanding of critical diagnostic tools and disease progression.
